MEDICARE: NW GA REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	057013	GA

General Provider Information

NPI Number	:	1891924577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NW GA REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	705 N DIVISION ST NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 N DIVISION ST NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1454
Country	:	US
Telephone Number	:	706-295-6298
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	THOMAS MULLER
Credential	:	M.D.
Telephone Number	:	706-295-6285

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/23/2009

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Directions to “NW GA REGIONAL HOSPITAL ” Practice Location

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